title: Confocal laser endomicroscopy reliably detects sepsis-related and treatment-associated changes in intestinal mucosal microcirculation.
abstract: BACKGROUND
  Microcirculatory alterations play a central role in the pathophysiology of sepsis. We investigated probe-based confocal laser endomicroscopy (pCLE) to assess alterations in mucosal microcirculatory perfusion in vivo in a porcine model of septic shock and in patients fulfilling consensus criteria for severe sepsis.
  
  
  METHODS
  Septic shock was induced using a faecal peritonitis model in anaesthetized, mechanically ventilated pigs. Mucosal microcirculation was assessed using pCLE in the stomach, duodenum, terminal ileum, and rectum. Duodenal microcirculation was further evaluated in 10 patients with severe sepsis and in 8 healthy controls to quantify capillary diameter, capillary length, and functional capillary density (FCD).
  
  
  RESULTS
  In the animal model, FCD was markedly decreased in duodenal (P<0.001), ileal (P<0.001), gastric (P<0.001), and rectal mucosa (P<0.005) 4 h after induction of sepsis. After volume therapy, FCD partially recovered to 90.0% (duodenum), 94.4% (ileum), 95.4% (gastric), and 97% (rectum) of baseline values, indicating decoupling of microvascular and macrovascular flow. In septic patients, the mean capillary diameter (P<0.01) and FCD (P<0.05) in duodenal mucosa were decreased compared with healthy controls.
  
  
  CONCLUSIONS
  pCLE reliably detected and quantified microcirculatory alterations in the gastrointestinal mucosa in a porcine model of sepsis and in patients with severe sepsis. Our data suggest that pCLE is a promising tool to assess the efficacy of therapeutic interventions on mucosal microcirculation in real-time, even in the clinical context.
authors.affiliation: Clinic for Internal Medicine IV and.
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.forename: C
authors.initials: C
authors.lastname: Lautenschläger
authors.forename: B
authors.initials: B
authors.lastname: Petzold
authors.forename: Y
authors.initials: Y
authors.lastname: Sakr
authors.forename: G
authors.initials: G
authors.lastname: Marx
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002196:Capillaries / Q000473:pathology; D016022:Case-Control Studies; D004386:Duodenum / Q000098:blood supply; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D005753:Gastric Mucosa / Q000098:blood supply; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007082:Ileum / Q000098:blood supply; D007413:Intestinal Mucosa / Q000098:blood supply*; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010865:Pilot Projects; D012007:Rectum / Q000098:blood supply; D018805:Sepsis / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D012772:Shock, Septic / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D034421:Sus scrofa; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: drug therapy; microscopy, confocal; perfusion; plasma substitutes; shock